Flunitrazepam (Rohypnol)

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Flunitrazepam, trade name Rohypnol, is a central nervous system
depressant
in a class of drugs called benzodiazepines. Benzodiazepines are
sedative-hypnotics used to treat anxiety, insomnia and sleep disorders,
and seizure disorders; they are also used as skeletal-muscle relaxants.
1 (Sedative-hypnotics are dose-dependent
drugs; lower doses promote sedation and relaxation, higher doses promote
sleep.2) Other benzodiazepines include
alpranzolam (Xanax), bromazepam chlordiazepoxide (Librium), lorazepam
(Atavan), and diazepam (Valium), all of which are prescribed in the United
States.3 Rohypnol, however, is ten times
more potent than Valium, and while commonly prescribed for anxiety and
sleep disorders in Europe, Latin America, and elsewhere, it was never
approved for use or sale in the United States.4
Rohypnol pills are smuggled into the United States, often via international
mail, and sold on the street in the manufacturers blister packaging
(similar to over-the-counter cold medicine or birth control pill packaging).
The round white tablets contain one or two milligrams of flunitrazepam.
They are odorless, tasteless, and dissolve undetected in
liquid.5,6
In response to reports implicating Rohypnol in
drug-facilitated
sexual assaults, the manufacturer reformulated the tablets. They now
appear as oblong green tablets that include a dye that turns blue when dissolved
in liquid, which makes the drug more easily detected in some
drinks.7 The original white tablets are still
available, however.8

Though not approved for use in the United States, Rohypnol (flunitrazepam) is
currently scheduled with other benzodiazepines as a
Schedule IV
controlled substance.9 However, under the
Drug Induced Rape Prevention Act, federal penalties for trafficking Rohypnol
are the same as those for Schedule I,
II, and III substances, depending on quantity.10

History

Swiss pharmaceutical company Hoffman-La Roche first described and developed
benzodiazepines in the 1950s. Roche modified the basic benzodiazepine
structure and introduced a number of tranquilizers 1960s and 1970s, including
Rohypnol in 1975.11 Though it is the most
widely prescribed sedative-hypnotic in Western Europe and is legal in many
countries, Rohypnol is not approved for manufacture or sale in the United
States.12,13
Reports of Rohypnol misuse in Europe surfaced in the 1970s, and in 1995 the
United Nations reclassified it from a Schedule IV to a Schedule III drug,
which requires more thorough record keeping of its legal distribution than
was previously in place.14
(Schedule IV
substances have a lower potential for abuse relative to
Schedule III substances.)
In the early 1990s, Rohypnol emerged as a drug of abuse and misuse in the
United States, and some states have reclassified it as a Schedule I
substance at the state level; the DEA is also reviewing the possibility of
reclassification.15

Methods of Use

Rohypnol tablets come in doses of one or two milligrams and users
may take one or more tablets at a time.16
The most common route of administration is oral. Users swallow or chew
the tablets, or allow them to dissolve under the tongue.17
They also crush pills and snort the powder to feel the effects more
quickly;18 the powder can also be sprinkled
on marijuana and smoked or dissolved and injected.19
Users feel the effects 15 to 20 minutes after ingestion, and they may last
for twelve or more hours.20

Users may take Rohypnol with other drugs, including
marijuana,
ecstasy,
LSD, and
alcohol to enhance
the effects of these drugs.21,
22 There are reports that
heroin users use Rohypnol
to enhance the effects of low-quality heroin or to relieve withdrawal symptoms.
Similarly, cocaine users
take Rohypnol to soften the negative effects of coming down from a
binge.23

Effects of Rohypnol

Rohypnol depresses central nervous system activity and brain function.
This depressed CNS activity manifests as sedation, sleep, muscle relaxation,
and reduced anxiety.24 When mixed with alcohol,
another CNS depressant, blackout, stupor, respiratory depression, and death
are more likely to occur.25

Addiction and Tolerance

Regular use of Rohypnol results in increased tolerance to the drug,
requiring users to take larger doses over time to achieve the same effect.
As with other Schedule
IV substances, abuse of Rohypnol may lead to physical dependence.
Withdrawal symptoms can range from restlessness and anxiety to more severe
effects similar to those of alcohol withdrawal, such as tremors, hallucinations,
and convulsions.30 Withdrawal symptoms may also
include headaches, muscle pain, tension, numbness, tingling of extremities,
loss of identity and delirium, and shock. Seizures caused by withdrawal from
Rohypnol may occur more than a week after use has stopped.31

Drug-Facilitated Sexual Assault

In the mid-1990s, reports surfaced that Rohypnol was being used in
drug-facilitated sexual assault, victimizing both men and women,
and it became known as a "date-rape" drug. Potential victims often are
unaware that they are in danger when sexual predators slip Rohypnol
into their drinks, where it dissolves and goes largely undetected.
When mixed with alcohol, Rohypnol incapacitates and induces amnesia in
its users, making them more vulnerable. Predators can appear to be helping
or rescuing a drunk friend, making it easy for them to move the victim
to another location. Victims under the influence of Rohypnol are unable
to fight back or negotiate with their rapists. They may be confused or
unable to remember the rape when the drug wears off; this can delay
reporting of the crime or hinder law enforcements response to it.
The inability to remember an attack can be traumatic to victims of
drug-facilitated sexual; they experience feelings of horror, powerlessness,
degradation, and humiliation related to not knowing or remembering what
happened to them.32

In response to the apparent trend of drug-facilitated sexual assaults,
the United States Congress passed the Drug Induced Rape Prevention Act
in 1996, which provided harsher penalties for the distribution of controlled
substances without the individual's consent and with the intent to commit
a crime of violence, including sexual assault. Under this act, the punishment
for the importation and distribution of Rohypnol includes up to 20 years in
prison and a fine; possession is punishable by three years and a
fine.33